Breastfeeding is a natural, but learned skill that takes time to develop! Babies are born with a sucking reflex but need to learn how to apply it to breastfeeding. Make sure your baby is learning good habits! The first days, your baby is responding to the sucking reflex. Hunger is a sensation they will learn to recognize.

The first 2 to 4 weeks, try not to use bottles to feed your baby. This allows breastfeeding and a good milk supply to become well established before the bottle is started. Unless there is a medical reason, babies do not need extra bottles. Newborns learn to suck differently on a bottle nipple, which may interfere with your baby learning to breastfeed. To protect your baby from becoming dehydrated in the first few weeks, pay careful attention to the number of wet and dirty diapers . It is your choice how long you continue to breastfeed. Any length of breastfeeding is good for your baby, although 1 year is recommended by the American Academy of Pediatrics.

Colostrum
This is the thick, yellow milk your baby gets the first few days. It is high in calories, contains germ-killing antibodies and acts as a natural laxative to help your baby pass the first sticky, black stools called meconium. Colostrum is small in amount but enough to meet your baby's nutritional needs until your milk comes in, typically 2-4 days after delivery.

When to Start It's best to start within the first hour after giving birth when both of you are alert. Ask for help to learn how to breastfeed the correct way. The first days are practice, so relax and be patient with yourself and your baby.

Positioning Proper positioning is essential to successful breastfeeding! Make sure you are in a relaxed and comfortable position. Your baby should always be turned towards you with your baby's tummy against your tummy. Don't worry about your baby not being able to breathe. Babies can usually breathe through their noses while feeding.

Latching-on Proper positioning and latching-on are the keys to preventing sore nipples! Pay special attention to both from the very start to avoid future problems! If your baby has been crying before feeding, he may be swallowing air, and may need to burp before latching-on. You may have to try many times to get your baby to latch-on the right way. Ask your nurse for help. Have patience. You and your baby will learn!

Waking Your Baby
Your baby may be sleepy for some feedings. If so, try to wake your baby for 5 or 10 minutes by changing diapers, unwrapping him, talking to him, rubbing his back or toes, trying to burp him, or washing his face. After the first few days, your baby should wake up and demand his feedings on his own.

How Often to Breastfeed
Each baby will have his own feeding schedule. Some babies will eat every 2 to 3 hours. Others may "cluster" feed, eating every 1 to 1 1/2 hours during certain parts of the day and going longer periods of time during other parts of the day. Offer your baby your breast whenever your baby shows signs of hunger (alertness, rooting, sucking). You are encouraged to try and feed your baby every 3 to 4 hours. Six to eight feedings are necessary per 24 hours the first 2 days. Your baby should progress to 8 to 12 feedings per 24 hours after those first 2 days of life. Use the breastfeeding log to record your baby's feeds for the first week. Frequent, unlimited breastfeeding is essential for successful breastfeeding. This gives you both a chance to practice breastfeeding, helps your milk come in earlier, and gives you a good milk supply. Milk production works on the supply and demand principle; as milk is removed, more is produced. When your milk comes in, the discomfort from engorgement will be less if you breastfeed often and on baby's demand.

How Long per Feed
The length of feedings should not be limited. Infants may be switched to the second breast after nursing vigorously on the first breast. If the infant continues to exhibit hunger cues, he may be placed again at the first breast. Sleepy or difficult to latch infants should be allowed to remain on the first breast for as long as they will nurse. Shorter feeding times do not prevent sore nipples. Proper positioning and latching-on prevent sore nipples. Try to feed your baby on both breasts each feeding. Begin each breastfeeding session on the breast offered last during the previous feed.

Burping
Breastfed babies may or may not need to burp as often as formula-fed babies do, but offer them a chance to burp during and after each feeding.

Breaking the Suction
The suction created while breastfeeding is very strong so do not try to pull your nipple away without breaking the suction first. Slide your finger into the corner of your baby's mouth along your breast until the suction is released.

Breast Care
Daily showers are all the cleaning your breasts need. Avoid getting soap on your nipples because soap can dry and irritate. Air dry your nipples after each feeding. Avoid the routine use of oils and creams. They can plug the Montgomery glands (pimple-like bumps on the areola) which produce a substance that naturally cleans and softens the nipple. You can apply breast milk or purified, medical-grade lanolin to your nipples to prevent or treat chapping. A good nursing bra should fit comfortably and provide support. If nursing pads are needed to control leaking, choose pads without plastic or polyester fibers to keep nipples dry and prevent soreness. Change pads as soon as they are damp to keep your nipples dry!

Preventing Sore Nipples
The nipple tenderness you feel at the start of a feeding when your baby first latches-on should go away as the feeding progresses and your baby's suck becomes less strong. If your nipples stay sore for the whole feeding or afterwards, Check to make sure your baby is positioned and latched-on correctly. Remember to air dry your nipples after each feeding.

Engorgement (Swollen Breasts)
The swelling of your breast caused by your hormones is called engorgement and is the start of your milk coming in. It usually lasts 24 to 48 hours. Your milk will start to come in between 2 to 4 days after giving birth, changing from a milky yellow to a bluish-white. Your breast is able to continually produce milk to meet your baby's demands. Therefore, you won't "run out" of milk. Your breasts should feel softer and less full after a feeding, but they are not "empty." You can prevent or lessen your pain from engorgement with frequent (every 2 to 3 hours), unlimited breastfeeding (20-40 minutes). If your baby can't breastfeed or is breastfeeding poorly, call your lactation consultant (719-8494). You will need to keep the milk flowing every 2 or 3 hours by pumping or hand expressing milk.

Breastfeeding and Working
Many women return to work while they are still breastfeeding. Part-time work or doing some of your work at home is best for breastfeeding. If this is not possible for you, you can still work and breastfeed as long as you pay careful attention to taking care of yourself, and maintaining a good supply of milk. Discuss your plans with your employer ahead of time so you can agree about the time you will need and the where you can go to pump milk. Make sure your day care provider knows how to properly handle breast milk and knows to not feed your baby just before you arrive from work. Breastfeed just before you leave for work and as soon as possible after you return. A day care provider close to work may make it possible for you to breastfeed at lunch time. Ask for hospital handouts regarding breastfeeding and childcare, and breastfeeding and employment.

You need to pump regularly during a full day at work or you will soon make less milk and may find you are not able to satisfy your baby's hunger when you are at home. Pump your breasts at the times you would have fed your baby at home. A large electric breast pump that can empty both breast at the same time works the best, if possible. Save your pumped milk to be fed to your baby while you are gone. To pump milk at work, a comfortable private place with a sink and a refrigerator is ideal. You should carry your milk home in a small cooler.

Pumping and Milk Storage

Breast Pumping
If you must be away from your baby longer than 4 or 5 hours, you will need to express milk by hand or use a breast pump to prevent engorgement and maintain you milk supply. Gently massage your breast a few moments before removing milk to help the milk begin to flow.

Types of Breast Pumps
You can buy a manual, battery-operated or small electric pump at stores with baby supplies. Smaller pumps work best for occasional use. When you need to establish, keep up, or increase your milk supply, the hospital grade electric pump works best. You may buy a back-to-work electric pump, or rent a hospital grade double electric pump and pumping kit at home health supply stores. Ask your nurse or lactation consultant which pump you should use for your individual needs.

Hand Expression
This can be done easily with a little practice. Put your thumb and first finger about 1 1/2 inches behind the nipple. This is where the milk sinuses are located. The milk sinuses meet your nipple like spokes on a wheel. Push your thumb and finger straight back toward your chest and then press them together with a slight forward rolling motion, lifting the nipple outward. Avoid sliding your fingers out of their original position or pinching your nipple. Repeat in a rhythmic motion as if your baby was sucking. Rotate your fingers around your nipple to remove milk from all the milk sinuses. This method usually takes about 20 minutes.

Milk Storage
Store breast milk in plastic bottles or disposable plastic bottle liners. Be sure to label each bottle with the date it was pumped. Refrigerate milk as soon as possible after pumping. It should then be used within 48 to 72 hours after pumping. Breast milk may be frozen in the freezer section of your refrigerator or in a deep freezer for 6 months. To thaw, move frozen milk from the freezer to the refrigerator 12 hours before you need it. You can also thaw frozen milk or warm refrigerated milk by placing the bottle in a bowl of warm tap water for a few minutes. Breastmilk should NOT be microwaved. Thawed breast milk that is stored in the refrigerator must be used within 24 hours, or be thrown out. Fat in breast milk will separate and rise to the top of the bottle. Gently swirl the bottle to blend the fat back into the milk. Any milk leftover in the bottle after a feeding should be thrown away.